A Handy Guide To Breast Care

Taking care of your breasts in pregnancy and beyond

Breast care is important throughout your life, from puberty, through the teenage years and into adulthood. During pregnancy your breasts will grow and change in response to pregnancy hormones. Your body prepares your breasts to produce the milk needed for your baby’s nourishment.

Your Breasts in Pregnancy

Your breasts are made of three different tissue types: glandular, fatty and connective tissue. Lobules (milk glands) and milk ducts are part of the milk manufacturing glandular tissue. The rest of the breast is made up of fatty tissue, and connective (fibrous) tissue holds everything in place. During pregnancy your breasts increase in size due to growth in the glandular and fatty tissues of the breast. Some women experience breast growth of about one to two cup sizes.

Breast tenderness and tingling are some of the earliest signs of pregnancy and your breasts will start to increase in size. In the second trimester, your areolas and nipples may begin to darken.

Breast pain and tenderness are common in the third trimester as hormones continue to prepare your breasts for nursing. As your due date draws closer, you may notice small droplets of milk at your nipple. This is called colostrum, a rich foremilk, that your baby needs in the first few days of life. Colostrum is nutrient-dense and full of antibodies which will help to strengthen your baby’s immune system. For some women, colostrum production begins after the baby’s birth.

Breast Care in Pregnancy

• Purchase a maternity bra when your regular size begins to feel tight, usually by the end of the first trimester. Choose a soft, breathable fabric in a design that provides support under the cups and good straps across the shoulders. Purchase two bras initially, then several more as your breasts increase in size.
• The small bumps or pimples on your areola are called Montgomery’s glands and they increase in size. These glands produce an oil that helps keep the areolas and nipples soft and moisturised. Soaps and shower gels can strip these natural oils, so use only warm water to clean your breasts daily.
• As your breasts increase in size, the skin may begin to itch. Apply a moisturiser to keep the skin soft and more elastic. It’s also advised if you are worried about stretch marks, which can occur when skin stretches, but if you are predisposed to them (its genetic), there isn’t much you can do to prevent them.
• If your breasts feel tender or heavy at night and this wakes you from a fitful sleep, wear a maternity bra under sleepwear to ease discomfort.
• If you are planning to breastfeed, purchase two nursing bras closer to your due date, so you can choose the right fit. These are handy as they allow easy access to the breast when nursing your baby, without having to unclip or pull down a shoulder strap.

Care Tips While Breastfeeding

• Continue to wash your breasts with warm water only, so as not to strip the oils produced by glands on the areola. This oil has a special smell and research suggests that the scent may help a newborn to find the nipple. It also has antibacterial properties, helping to keep germs away from the nipple.
• You don’t need to clean the breasts prior to breastfeeding, unless you use nipple cream that must be wiped off before feeding.
• Air dry your nipples for a short period after feeding, or pat dry with a soft cloth.
• You can use nipple cream, or even a little breast milk on your nipples after a feed, to keep areolas and nipples moisturised. Breastmilk can aid skin healing if you develop a crack on the nipple.
• Use nursing pads in your bra to keep the area dry and prevent embarrassing leaks through your clothing.

Top tip: Inverted or flat nipples are nipples that don’t stand erect from the areola but rather lie flat or turn inwards when stimulated (gently pinched or rolled between two fingers). This can make it difficult for your baby to latch. First up, try to stimulate your nipple before a feed. This may be enough to push it forward so your baby can get a good latch. If this doesn’t bring the nipple forward, purchase a nipple puller, a suction cup similar to a breast pump. The cup (shield) fits over the areola and when pumped, the suction helps to elongate the nipple. It can be used before feeds to help latching and to stimulate the flow of milk. Breast shells, silicone shields, usually worn to protect cracked or sore nipples, can be worn under clothing between feeds to help draw out the nipple.

A Word on Breast Cancer

Checking your breasts regularly for changes or problems is as important now as it is in any life-stage. Although a diagnosis of breast cancer is rare during pregnancy, breast cancer is one of the more common cancers discovered in pregnancy, while breastfeeding, or within a year after delivery.

The changes pregnant and new moms experience during pregnancy and while breastfeeding can make monthly breast examinations difficult. These changes – swollen and tender breasts and lumps – can make it difficult to determine if further assessment is necessary. Even though your healthcare provider will check your breasts at your prenatal visits, you should continue to examine them every month.

If you notice any of the following changes, see your healthcare provider for an assessment. Do not wait until after the delivery or when you stop breastfeeding to have them checked.

• Any lump or thickening in the breast or under the arm
• A change in the size and shape of the breast that concerns you
• A dimple or puckering of the skin around the breast; orange peel skin
• A nipple that turns inwards
• Fluid discharge that isn’t breastmilk or contains blood
• Red, scaly or swollen skin on the breasts or around the areola and nipple

After an initial examination, your healthcare provider may recommend a mammogram or ultrasound, if deemed necessary. A mammogram will only be done in pregnancy for diagnostic reasons. Screening tests should be scheduled for after the baby’s birth.

How you feel about your breasts is very personal. Some women enjoy the increase in their size and shape during pregnancy, but for others, the changes can be daunting and even stressful. These feelings are normal and warranted – your breasts are a unique part of you. Learning to cope with and accept the changes are a part of a positive pregnancy and breastfeeding experience.

If you have any concerns about your breasts, physically or emotionally, reach out to your midwife or healthcare provider for assistance.

Resources: https://www.medela.com/; https://cansa.org.za/; https://www.everydayhealth.com/; https://my.clevelandclinic.org/; https://www.thewomens.org.au/; https://www.healthline.com/; https://www.nationalbreastcancer.org/; https://www.cdc.gov/; https://www.cancer.org/; https://www.verywellfamily.com/; https://www.whattoexpect.com/; https://www.llli.org/